Ask NurseGail.com: How Do I Help A Kid With A Nosebleed?

A reader wrote in and asked:

My nephew got a bloody nose and I couldn’t remember what to do.  How do I help a kid with a nosebleed?  Tilt the head forward or back?

Gail Ingram, a primary care nurse practitioner with over 10 years experience as a registered nurse, responds:

Nosebleeds are a frequent occurrence for kids under 10 years.  A bloody nose is usually more alarming than dangerous, so remain calm.  And remember, even without your help, most nosebleeds will stop on their own (although it is a frightening and messy affair that should be avoided).

WHAT TO DO FOR A KID WITH A NOSEBLEED

1. Reassure the child that they’ll be OK and you will help them.
2. If the child is old enough to follow directions, ask them to gently, one time, blow their nose into a tissue.  This might increase the bleeding for a moment, but it will be fine.  This clears any foreign bodies or clots.  Use your best judgement and skip this step if the child is too upset.
3. Stand or sit the child up and lean them FORWARD.  If in the standing position, bend forward at the waist.  DO NOT lie the child down or tilt their head back.
4. Pinch the soft part of the nose closest to the nostril opening.  Do not pinch between the eyes or the bony bridge.  Do not press just one side–pinch both sides–even if only one nostril is bleeding.
5. Pinch for at least 5 minutes.  Use the timer on your phone.  5 minutes will seem like an eternity.
6. A small bag of frozen peas wrapped in a towel or cold washcloth held to the face is helpful, but in many cases with kids, it is impossible to apply.
7. Once the bleeding stops, instruct the child not to blow or pick their nose.  Good luck with this one.
8. Keep the child sitting up, resting, for 20-30 minutes.  This is a good time for coloring and puzzles.
9. If the nosebleed returns, try to remove any large clots from the nostril(s).
10. Following the directions on the package insert, you may want to place a cotton ball soaked with a decongestant spray (like Afrin or neosynephrine) in the affected nostril before pinching and repeat the above steps.

The most common cause of nosebleeds in children is nose picking and dry air.  When asking a child how they got a bloody nose, don’t ask, “Were you picking your nose?”  Instead ask, “What finger did you use to pick your nose?”  You’ll get a much more honest answer.

A humidifier in a child’s room at night along with a daily over-the-counter saline mist spray can help keep nasal passages moist.  Talk to your pediatrician about allergies and frequent colds as these are also culprits.

Depending on the amount of bleeding and how much blood the child swallowed, they may complain of a stomach ache.  Blood in vomit or dark colored stools is not uncommon following a heavy nosebleed.

As a veteran nurse, I use sodium percarbonate products (like OxyClean) to remove blood stains from my scrubs.

Hope this helps!

–Gail Ingram NP

Note:  This information is for healthy kids over 2 years of age with acute bleeding.  If there is difficulty breathing (spitting or regurgitating blood), chest pain, fainting, confusion, or the bleeding won’t stop, call 9-1-1.   Don’t attempt to drive the child, call an ambulance.

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